Laserfiche WebLink
Date fn/,T � <br />Application For <br />PUBLIC WORK� PERMIT <br />Print or Type Cnly <br />Mailing Address <br />'uoi�c Avo�ks Pnimn` a A <br />gi0g. Depl. i —11__� , �U <br />Pu�lic Worhs Fee <br />,���� F�� s -- <br />Less FpO�� Fee Pala $ _ <br />3alance Oue $ <br />��f �o / <br />Zip Phone <br />City Zip Phone <br />rlS1r�/ /_�Nrc r� h � <br />Describe Proposed Work (Y„—y1, � — <br />Project Address (il known) <br />A�lach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Pwperty Lines <br />• Oulline and dimensions of all existinq and <br />proposed siructures an �he bt <br />• Existing and proposed ulilities <br />PERMIT CONDITIONS <br />• Centerline of sireet <br />• Indicate Norih <br />• Show any proposed grading changes <br />• Show measuremenis <br />1. All calls for inspeclion shall be made 24 hrs. in advance - phone 259 •881 5, <br />2. All work shall be perlormed in accordance with this permil and wrrent City of Everett Des�gn and Consiruction <br />Standards and Specilications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424-5555. <br />f�vB�ic �o,e�s i�Fi_•,��,� .t/or ��qu.,e�� <br />Approved for Construct!on <br />FINAL INSPECTION <br />Appwved as Constructed <br />e��erect PUBLIC WORKS DEPARTMENT <br />� 3200 Crdar Slreet <br />Evere��. WA 98201 <br />Phone:259�8815 <br />(•as 8� <br />��� <br />ACKNOWLEDGEMENT OF CONDI710NS <br />� <br />� <br />0 <br />a <br />The undersignetl owner/applicanl hereby agrees to t�old and save harm- <br />less the City of Everelt Irom any and all claims for damages, costs, <br />ezpenses, or causes uf action �hat may arise because of installation <br />and maiMenance ol the improvement or other ri9ht�of-way use heretr, <br />applied tor and turiher agrees to remove same upon notice from the <br />Da�e City and to replace pubiic propeny damayed thereby. <br />D�te <br />SignaWrc of Applican� Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PUFSUED TO COMrLETION. THIS PERMIT h1AY BE <br />CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON i HIS <br />PROJECT OVER 90 DAYS GUR�TION. <br />